Tales Of The New Crown: Federal Reserve Buys Treasury Bonds & Mortgage Back Securities - Emergency Manager Emperor Pence & His Procurement Consortia Task Force Falsely Advises Trump About Google

First, this happened....

Then, this happened....

Then, this happened....

It seems the Emperor Pence is on rotation.

Trump focused on humans.

Emergency Manager Emperor Pence & His Procurement Consortia Task Force focused on profit.

My favorite chick seems to be a Predictive Modeling Crapper who was strongly encouraged to put a human spin on the subject of children, where she spoke of her own children.

Well, at least that was a start to get them to focus on the humans, and not revenue maximization for the Public Private Partnerships.

Google Sister Science Company Verily Launches Coronavirus Screening Website

Verily, Google’s sister company, has launched a screening website for those who want to get tested for COVID-19, but it’s limited to people in the Bay Area of California, the Verge reported.

“It’s more of a pilot program than a public health utility,” the website reported.

You have be 18 years of age or older, be able to speak English, and be a U.S. resident, according to the story. It resembles the program a Verily spokesperson described last week, “not the expansive triage system that the Trump administration promised,” the Verge said.

The initial question is “Are you currently experiencing severe cough, shortness of breath, fever, or other concerning symptoms?” the story said.

A “yes” answer prompts a message that the website is “not the right fit” and to seek medical attention.

“This screener was developed in partnership with government health officials,” a Verily spokesperson told the Verge. “The initial question is meant to ensure that anyone who is seriously ill does not come to our sites because they are not prepared to provide medical attention. We are early in this pilot and are going to be learning more that will help us refine this COVID-9 risk screening and testing.”

A “no,” answer prompts the user to sign in with a Google account and sign a consent form allowing data to possibly be shared with public health officials. A series of questions follows including questions about symptoms, travel and work responsibilities. It takes about three minutes to read and respond, the story said.

“Ultimately, our goal is to help local authorities expand testing access in California as the need continues to increase,” the company said. “The program is in its early stages, and we will take the time to assess operations at pilot sites in the Bay Area before rolling out to additional sites. We are working closely with Governor Newsom’s office, federal authorities and local public health authorities to ensure we have the right capabilities in place to help more people over the coming weeks.”

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Did Mary Mayhew Leave CMS To Cover Up Medicaid Fraud In Florida For The Right Price?

Now, why would Mary want to leave Maine and go to Florida to run their child welfare programs under Medicaid?

I know!

Money, money, money.

She is a corporate lobbyist, with a hospital background, deep down in her soul.

Perhaps DeSantis knows there is going to be a dark period which shall linger over Florida for what they have done to the children.

Perhaps Mary knows there is going to be a dark period dark period which shall linger over the U.S. for what they have done to the children.

Perhaps Mary was recruited to cover up Medicaid Fraud In Child Welfare.

Mayhew leaves Trump administration after less than 3 months for Florida post

Mary Mayhew

AUGUSTA, Maine — The former Maine health and human services commissioner who led a conservative transformation of the state’s welfare system under former Gov. Paul LePage has left her job overseeing the federal Medicaid program after less than three months.

Mary Mayhew was hired by the administration of President Donald Trump to run Medicaid in mid-October, but she resigned by Friday for a new post under Florida Gov.-elect Ron DeSantis, a Republican, according to the federal Centers for Medicare and Medicaid Services.

Mayhew, a former hospital lobbyist who ran the Maine Department of Health and Human Services under LePage from 2011 until 2017, became a Republican policy star and Democratic bogeyman during a tenure in which she oversaw steep reductions in the state’s welfare rolls and ran point on the former governor’s crusade against Medicaid expansion.

In a statement first reported on by The Washington Times, Mayhew said she was “grateful” for the federal job and the Trump administration’s “vision for state flexibility” in the Medicaid program made her want to return to administer programs at the state level.

Mayhew has Florida connections. She has traveled the country pushing conservative welfare policy for the Foundation for Government Accountability, an advocacy group based there and run by Maine native Tarren Bragdon, whose brother runs another firm that worked for the 2018 Republican gubernatorial primary campaign in which Mayhew finished third of four candidates.

In Maine, much of Mayhew’s work looks slated to be reversed by Gov. Janet Mills, a Democrat who took over for the term-limited LePage on Wednesday after a Democratic wave election flipped the Blaine House, Maine’s 2nd Congressional District and the state Senate.

On the first full day of her tenure on Thursday, Mills fulfilled a campaign promise by directing the department Mayhew once ran to begin implementing Medicaid expansion to an estimated 70,000 Mainers under the Affordable Care Act, which was approved by voters in 2017.

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DHHS DARPA Brett Giroir Sucks - Senate Slams For Medicaid Fraud In Pharmaceuticals, Child Welfare, Opioids & Trafficking Tiny Humans

Why do we have a Defense Advanced Research Projects Agency (DARPA) military official running the U.S. Department of Health and Human Services?

This should be terrifying.

I only say because he is not responding to the Senate grilling on lack of oversight in Medicare and Medicaid funding the pharmaceutical industry and its role in opioids.

HHS refused to respond to Debbie Stabenow about reducing the pricing of Suboxone. He refused to agree to reducing the price that was $1 in 2005 which is now a 4000% increase in price, with new presidential mandates that law enforcement carries it.

The Senators are going after the Medicaid grant funding to NGO programs where nothing really reaches the people.

There was a question about the Families First Act providing assistance to families, like it was designed to do, that has never happened, so the children are not Legally Kidnapped and put into Foster Care and Adoption programs, that are funded through NGO programs where nothing really reaches the people.

Senators just dropped "fraud & abuse" and asked how come HHS is not reporting it to CMS for investigation.

HHS just sat there.

Damn, Claire McCaskill just slammed Giroir for not doing anything about going after these pharmaceutical companies for fraud & abuse, and she even called the corporations out as being greedy from people dying.

She asked for an immediate rule to go after pharmaceuticals for Medicaid fraud; HHS grunted.

Dean Heller just put him on the hot seat asking about school, education youth programs for prevention.

Giroir kicked the responsibility to the states on how they procure services, which are privatized, and had could not respond to the child welfare component.

I keep watching to see if his sidekick Brandt is mannequin puppet because she is on point when it comes to dancing around an answer with him.

She is clueless and only follows orders.

Her tag line "this is something we have been looking at and believe a potential good tool..." I should have taken a tally on how many times she used this line.

Yes, she needs to go.

Griroir's response to what HHS is doing about child welfare services..."this is something we have been looking at and believe a potential good tool..."

I do not have a law degree so I have no Code of Ethics but my own of which to adhere, so...

Admiral Brett Giroir sucks.

Check his finances and past projects, he has deep privatization and child welfare background.

Here is a link to the hearing because C-SPAN blocked me.

https://www.c-span.org/video/?444267-1/health-officials-testify-medicare-medicaid-role-opioid-crisis&live

ADM Brett P. Giroir, M.D.

Assistant Secretary for Health (ASH)

HHS Office of the Secretary

ADM Brett P. Giroir, M.D., was sworn in as Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS) on February 15, 2018. The Assistant Secretary for Health leads development of HHS-wide public health policy recommendations, oversees 11 core public health offices — including the Office of the Surgeon General and the U.S. Public Health Service Commissioned Corps, which has approximately 6,500 uniformed health officers who serve in nearly 600 locations around the world to promote, protect and advance the health and safety of our nation and our world. He also oversees three Presidential and 11 Secretarial advisory committees.

Dr. Giroir is a physician, scientist and innovator. He is a former medical school executive and biotech startup CEO, and has served in a number of leadership positions in the federal government as well as academia.

From 2014-2015, Dr. Giroir chaired the Veteran’s Choice Act Blue Ribbon Panel to reform the U.S. Veterans Health System. During the Ebola emergency, he directed the Texas Task Force on Infectious and Disease Preparedness Response.

He was executive vice president and CEO of Texas A&M’s Health Science Center from 2013-2015, having earlier served as vice chancellor of strategic initiatives (2011-2013) and vice chancellor for research (2008-2011) for the entire Texas A&M University system. A pediatric critical care physician and a former member of the American Board of Pediatrics, Dr. Giroir cared for critically ill children for 14 years, and was the first chief medical officer of Children's Medical Center of Dallas (now Children's Health). He was also a professor at the University of Texas Southwestern Medical Center from 1993-2003, and held a number of positions in academic and hospital leadership.

Dr. Giroir has had a significant federal portfolio. He directed the Defense Sciences Office of the Defense Advanced Research Projects Agency (DARPA) from 2006-2008. In this capacity, he worked regularly with the White House, Congress, and NIH, CDC, DHS and CIA leadership on national priorities, strategies and programs. He joined the office in 2004 as deputy director, and between 1998 and 2004, was a member of the Defense Sciences Research Council.

Dr. Giroir has authored or co-authored almost 100 peer-reviewed scientific publications and holds patents on a number of biomedical inventions. He is the recipient of numerous honors and awards, including the U.S. Secretary of Defense Medal for Outstanding Public Service, the American Heart Association’s President Lyndon Baines Johnson Research Award and the Society of Critical Care Medicine’s Annual Scientific Award. He was the nation’s high school debate champion in 1978. He received a bachelor’s degree in biology from Harvard University in 1982 and a medical degree from the University of Texas Southwestern Medical Center (Dallas) in 1986.

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CONYERS: House Democrats to Trump Administration: Florida Nursing Home Tragedy Is a Wake-Up Call to Protect the Fundamental Rights of Residents Against Abuse

WASHINGTON – In the wake of disturbing reports of the neglect of nursing home residents in the wake of Hurricanes Harvey and Irma, 46 members of Congress called on Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma to maintain current protections for elder Americans against abuse in nursing homes.

In Florida, 12 residents died and more than 100 were hospitalized after a long-term care facility failed to evacuate residents after losing air conditioning in the aftermath of Hurricane Irma. In Texas, similar abuse occurred at a facility that refused to evacuate despite severe flooding. The letter is led by Representatives David N. Cicilline (RI-01), John Conyers, Jr. (MI-13), Henry C. “Hank” Johnson, Jr. (GA-04), Jerrold Nadler (NY-10), Linda Sánchez (CA-38), and Suzanne Bonamici (OR-01).

They wrote: “The horrific reports of abuse at facilities in Florida and Texas in the wake of Hurricanes Irma and Harvey underscore the need for your agency to reconsider upending the legal protections of those who have worked and saved for their entire lives to retire with dignity. This is a time when we should be protecting our nation’s seniors, not rolling back their fundamental right to hold wrongdoers accountable for neglect and abuse.”

Last year under the Obama Administration, CMS finalized a strong rule that prohibited the use of pre-dispute, mandatory (“forced”) arbitration clauses in nursing home admission agreements.

Nursing-home residents stand to lose virtually every cause of action against unscrupulous caregivers unless these current protections against forced arbitration in nursing-home admission contracts are preserved.

As the letter notes, following an extensive notice-and-comment rulemaking process, CMS determined that forced arbitration undermines the ability of health investigators to prevent and remedy abuse in nursing homes.

But under the Trump Administration, CMS has already begun the process to end this protection.

The letter follows a letter from House Democrats—including Representatives Johnson, Cicilline, Conyers, Nadler, and Sanchez—in 2015 that called on CMS to adopt these protections.

The group of House Democrats denounced plans by CMS Administrator Verma to roll back existing protections, writing “Americans in nursing homes deserve better. It is vital that residents and their families are able to enforce their rights and hold nursing home operators accountable for dangerous facility conditions and the inhumane treatment of residents. We strongly urge CMS to protect the health and safety of nursing home residents, particularly in light of recent events, by maintaining the current prohibition of forced arbitration clauses in nursing home admission contracts.”

Congressional Letter To CMS On Nursing Home Protections 10032017 by Beverly Tran on Scribd

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DOJ needs to create a special Child Medicaid Fraud Task Force

Dr. Phil: “Foster Care is a Social Circumstance, Not a Mental Illness”

The House Ways and Means Subcommittee on Human Resources heard testimony yesterday on the disproportionate use of psychotropic medications on foster youths, and the president’s $750 million proposal to address the issue.

The hearing yesterday was spurred along by the presence of a celebrity witness, talk show host “Dr. Phil” McGraw.

“These drugs can change and even save lives,” McGraw told the committee. But with foster youths, they are “too often misused as chemical straitjackets,” prescribed to mitigate “undesirable behavior” and make foster youths “less inconvenient.”

The use of psychotropics on foster youths has received attention from several corners in both houses of Congress and the White House in recent months. President Barack Obama proposed in his fiscal 2015 budget a $750 million, 10-year plan to help states develop different ways to address mental health challenges among foster youths.

67 youth gathered in Washington for Foster Youth Shadow Day.
 Dr. Phil, in town to address them, told a Congressional Committee
 that psychotropic drugs were too often
 used as “chemical straitjackets” on foster youth

Last week, Democrats on the Senate Finance Committee said the committee plans to “play offense” on what Sen. Tom Carper (D-Del.) called “mind-bending drugs.”

Ways and Means leadership from both parties asserted an interest in addressing the issue. “This is a bipartisan issue,” said Subcommittee Chairman David Reichert, “We are together on this.”

A 2011 law shepherded through Ways and Means required states to share their prescription and monitoring protocols with the Administration for Children and Families (ACF), a division of the Department of Health and Human Services.

“Everyone agrees that these drugs are flowing too much,” McGraw said. “The real question is, why? Why is this happening?”

Medicaid fraud.

What was not addressed in this hearing was:

1.  The only way for a parent to access comprehensive mental health for a child is to "voluntarily" place the child in foster care.  This is the only way Medicaid pays for treatment.  "It must be noted that "voluntary" is registered as and reported a "neglect" data.

2. A child diagnosed with a mental health disorder in foster care garners higher cost reimbursements from Medicaid.  Foster children will "automatically" be diagnosed in order to increase revenues.

3. Kickbacks, Physician referrals, phantom billing and double billing are common factors as the Centers for Medicaid and Medicare and the States have no enforcement mechanism to address this type of fraudulent activity.

The Department of Justice needs to create a Child Medicaid Fraud Task Force.

Testimony of Stephen Lord, GAO to Ways and Means Committee on Psychotropic Overmedication of Foster Care Yo...

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Michigan Proposal To Merge Medicaid and Medicare Forgot Oversight

Here is the Michigan Proposal for Medicare/Medicaid Eligibility Proposal.

 In 2011, Michigan was competitively selected to receive funding through CMS’ State Demonstrations to Integrate Care for Dual Eligible Individuals. As part of this Demonstration, CMS provided support to the State to design a demonstration proposal that describes how it would structure, implement, and monitor an integrated delivery system and payment model aimed at improving the quality, coordination, and cost-effectiveness of services for dual eligible individuals. 

Michigan is one of 15 states that was chosen for policy development of the integrated care model under the Affordable Care Act, or more readily recognized as "Obamacare". This is the first stage of examining a single payer model. I sit on the State Medicaid Advisory Group and have worked on this. Unfortunately, no one wanted to hear me on integrating a violation mechanism to the attorney general as there is no operational oversight component of the integrated model.

The state Medicaid Fraud Control Unit, which does nothing, will not have jurisdiction with this proposal and neither will the Medicaid Integrity Program.

Medicaid and Medicare fraud is outrageous in Michigan. That is why the H.E.A.T. task force, the DOJ and HHS OIG partnership. has Detroit as one of the first five cities to launch the task force.

I also have concerns that there are no complaint or exclusionary databases recommendations for quality improvement measurements for delivery and efficiency of services.

Michigan seems to be bucking for the Managed Fee for Service model.  Unlike the Capitated model where the state, CMS and a health plan enter into a percentage payment formula, the "managed" model would find ways to save money by reducing costs.  Michigan has already taken legislative initiatives to begin to benefit off its "gaming-the-system" law.

Michigan could "reduce costs" if it would admit it has a severe false claims issue.  Would it not make sense to use the single audit to improve a single payer system?

 Invitation for public comment: We welcome public input on this proposal. To be assured consideration, please submit comments by 5 p.m., May 30, 2012. You may submit comments on this proposal to MI-MedicareMedicaidCoordination@cms.hhs.gov. 

  Michigan Demonstrations to Integrate Care for Dual Eligibles Demonstration Proposal Voting is beautiful, be beautiful ~ vote.©

The Child Was Loved Until The State Stepped In

Courtesy of Dr. I. M. Bonkers

Director of the Bonkers Institute

for Nearly Genuine Research

As I read this letter from the U.S. Health and Human Services to the States, I became absolutely disgusted knowing that nothing will ever change.  The reason why is because of the privacy laws in child welfare.  It would not be in the best interests of child welfare organizations to tell the truth.

The truth is the failure of HHS to even recognize that children are Legally Kidnapped and put in foster care for reasons other than what the child abuse propaganda will brainwash you to believe.  A child can be put into foster care because of poverty, a lack of medical coverage, the fact the parent is an undocumented immigrant, or parental rights to a previous child has been terminated based on the preceding items in this list.

In all these instances the child was loved until the state stepped in.

The States will not do anything due to the simple fact that the privatized child welfare organizations will never face any penalty of their actions.  Ever.

Let me give you an example.  Foster care caseworkers perform Axis III diagnoses.  A visiting physician will come through and see a child for less than five minutes to write a script.

States do not even report incidences of rape, suicide and torture in foster care so what makes you think they are going to be forthright in reporting polypharmacy let alone justification of labeling kids with the labels that killed Rebecca Riley.

Rebecca Riley (April 11, 2002 – December 13, 2006), the daughter of Michael and Carolyn Riley and resident of Hull, Massachusetts, was found dead in her home after prolonged exposure to various medications, her lungs filled with fluid. The medical examiner's office determined the girl died from "intoxication due to the combined effects" of the drugs Clonidine,valproic acid (Depakote), Dextromethorphan, and Chlorpheniramine and that her heart and lungs were damaged due to prolonged abuse of these prescription drugs. Police reports state she was taking 750 milligrams a day of Depakote, 200 milligrams a day of Seroquel, and .35 milligrams a day of Clonidine. Rebecca had been taking the drugs since the age of two forbipolar disorder and ADHD, diagnosed by psychiatrist Kayoko Kifuji of the Tufts-New England Medical Center.

State Medicaid Fraud Control Units are typically housed in the State Attorney General's Office.  The State Attorney General advocates for these child welfare organizations and the state, which is the legal guardian of foster children.  To prosecute the entities it contracts and pays would be a severe conflict of interest and would put a financial strain upon state revenues.

How can HHS even think it can develop "webinars" to stop this multi-billion dollar industry of drugging children?  This is not even a bandaid, this is like pretending the shit the elephant just dumped in the room does not stink.

Come on Pamela, George and Donald.  I expect much better from you.
State Director Letter - Joint ACF CMS and SAMHSA on Psychotropic Drug Use in Foster Care

Arizona Adopts Michigan Child Medicaid Revenue Maximizing Fraud Schemes

Here is a terse op-ed by Barbara A. O'Brien commenting on Arizona's Child Protective Services Governor Task Force.

From what I have gathered, Arizona has done absolutely nothing in the areas of Continuous Quality Improvement for almost 6 years.

Couple that with the fact that the state is expending billions to snatch children of undocumented immigrants to shove them in foster care instead of promoting family, you have just found the underlying reason why Arizona has created a CPS task force.

So what other reasons exist for Arizona to revamp its Child Protective Services at this particular time?  I found the reason here, as stated by Cindy Mann:

Under Brewer's plan, parents earning between 75 percent and 100 percent of the federal poverty level would have remained on AHCCCS, but no new parents would be eligible and those who fell off the rolls for any reason could not get back on.

AHCCCS estimated that about 30,000 people, or half of the 60,000 parents in that category, would lose benefits in the first year, for savings of $17 million.

Mann said U.S. Health and Human Services Secretary Kathleen Sebelius did not believe eliminating coverage for low-income parents furthered the Medicaid mission.

Sebelius and the CMS also denied a plan to require AHCCCS members to re-enroll every six months, instead of annually. The proposal would have saved an estimated $15 million, primarily because people would fail to sign up in time or become ineligible.

Cindy Mann, is the Deputy Administrator Center for Medicare & Medicaid Services Director Center for Medicaid, CHIP, and Survey and Certification.

To better understand the motivation of Arizona to establish barriers for its citizens to this federal program, one may look no further than of the Michigan's working model, designed by Maura Corrigan.

Here is how it works.

CPS task force needs real experts

Gov. Jan Brewer labels the task force she appointed to improve Child Protective Services as comprised of "the best child-safety experts in Arizona."

However, I don't believe there is one member who has psychology, counseling or child- and family-development credentials and experience.

Given the severe lack of effectiveness of CPS over the years, why does anyone believe that yet another gathering of the same "experts" (legislators, police and other assorted businesspeople and child-welfare agency administrators) will be able to produce miraculous reform?

Why doesn't the task force include a licensed child psychologist, counselor, family therapist, or social worker who works with children and families?

Someone who not only understands abuse, neglect, mental illness and substance abuse, but who works directly with these phenomena.

Someone skilled in conducting interviews in a way that gleans honest answers and instills motivation to seek help. Our children deserve better!

-- Barbara A. O'Brien, Phoenix

Legally Kidnapped was triggered to address by a surprisingly malicious comment.

I responded in my traditional fashion.

In order to improve the functioning and image of Child Protective Services experts must represent all facets of the industry, not solely under the lens of the objective of removal of children based upon the codification of poverty being the crime of abuse and neglect. A key area when approaching the improvement in delivery and quality of services is in the administrative structures of transparency and accountability. 

Arizona has not demonstrated a very credible track record when it comes to properly administrating its child welfare services, documented in this federal report of more than $21 million in false claims. 

http://www.scribd.com/doc/3...

If Arizona has a pervasive issue with drug usage within its communities which deems removal of children, it would behoove society as a whole to identify and deliver remedy to ameliorate it. This is called, from a basic economic perspective as investment in human capital, or rather investment in the best interests of the children so they may mature for society to reap the profits of a productive, tax paying citizen. 

As it stands, the use of perjorative statements such as "bottom of the dung heap" presents, not only a lack of substance in your argument, but reduces it to an ad homenin fallacy. 

Simply put, you have been reduced to throwing sticks and stones as you have no logical retort to this op-ed. 

GOPinNOV, if your daughter, who is a representative, contractual arm of the State of Arizona, feels that its citizens and the clients of her employer are "bottom of the dung heap", then it would behoove her to find a new profession for the greater good of the State. In posting this response, you have exposed the bias when it comes to case recommendations for referral of services and reunification, which should be construed as a hate crime, calling for intervention of the State Attorney General to investigate possible civil rights and false claims violations. 

State Attorney General Tom Horne must also be included in this task force as it is the duty of his Office to investigate Medicaid fraud, waste and abuse in child welfare. At this time, I shall commend Governor Brewer for the creation of this task force and graciously offer my expertise to provide the omitted voice in the area of administration oversight and federal compliance. 

Beverly Tran 



In the end, these Child Protective Services Task Forces will only be hand picked by those individuals who are willing to coddle the whims of those who want to rebuild their economy of the backs of the poor and their children, the oldest form of survival.

Hey Berwick, What About Medicaid Fraud In Child Welfare?

Hello people...is anyone at home?  


I have to give a big "duh" shout out the the Republican leadership who are about to grill Donald Berwick.


For starters, precious daaaaaaarlin's, Berwick is Chief Administrator for the Centers for Medicare & Medicaid, not just the Medicare section.  Instead of worrying about the what is being restructured as we speak, why don't you ask him about the Medicaid fraud in child welfare?  It seems I am the only person to always ask.


See, Medicaid fraud in child welfare is an instant recovery function or is it not that important.  Oh wait, how can I be so forgetful.  Anything dealing with child welfare is a secret, including but not limited to fraud, waste and abuse.


It seems whenever someone raises the issue of child welfare fraud, the Republican leadership starts soapboxing on Medicare fraud while the Democratic leadership clammers about saving it when it is going no where anytime soon.  The subject of Child welfare fraud is taboo in Washington, D.C.  I am attacking the issue head on.

STOP MEDICAID FRAUD IN CHILD WELFARE

Medicare Chief Berwick to Make First Appearance Before Congress Next Week

Dr. Donald Berwick was appointed to the post of medicare administrator in July in a recess appointment. Photographer: David Rogowski/Bloomberg

Medicare Administrator Donald Berwick will face critics of President Barack Obama’s health- care overhaul next week, his first appearance before Congress since he was appointed in a process that bypassed the Senate.

Berwick will testify at a Senate Finance Committee hearing onMedicare, the health insurance program for the elderly and disabled, and the Medicaid program for the poor, the panel said today in a statement. Republicans such as the panel’s ranking member, Senator Charles Grassley of Iowa, for months have said they want to question Berwick on the health-care law.

Berwick doesn’t have plans to testify before the House of Representatives, where Republicans take control in January after winning a majority in elections on Nov. 2. He manages the Centers for Medicare and Medicaid services, controlling a projected $962 billion this year.

“We expect to get to know Mr. Berwick very well,” Sage Eastman, a spokesman for Republican Representative Dave Camp of Michigan, said in an e-mail today. Camp is in line to take over the House Ways and Means Committee, which oversees Medicare.

Berwick was named to the post in a recess appointment while Congress was out of session in July, bypassing the traditional Senate confirmation process.

The overhaul would reduce the growth of spending in Medicare and Medicaid by about $455 billion over a decade, according to the Congressional Budget Office, the accounting arm of Congress.

Jessica Santillo, a spokeswoman for the Department of Health and Human Services, of which Medicare is a part, said that Berwick decided to testify after being invited by Senator Max Baucus, the Montana Democrat who chairs the Finance Committee.

“There are a lot of questions that he’ll need to answer next week,” said Senator Orrin Hatch, Republican of Utah, in an e-mail. Hatch is in line to be the ranking Republican on the finance panel next yea

Awww, they were listening...

Awwww, they were listening...

MEDICAID RECOVERY AUDIT CONTRACTORS RULE ANNOUNCED TO HELP REDUCE IMPROPER PAYMENTS
CMS ANNOUNCES EDUCATION EFFORT TO SUPPORT PROGRAM

The Centers for Medicare & Medicaid Services (CMS) today proposed new rules to help states reduce improper payments for Medicaid health care claims through the use of Medicaid Recovery Audit Contractors (RACs) as part of the Affordable Care Act’s larger strategy to crack down on waste, fraud and abuse in the health care system.  Medicaid RACs are contractors, working for States, that will audit payments made to health care providers to identify Medicaid payments that may have been underpaid or overpaid, and recover overpayments or correct underpayments, similar to the RAC program in Medicare.

“Reducing improper payments is a key goal of the Administration, and the tools provided by the Affordable Care Act will help us achieve that goal,” said CMS Administrator Donald Berwick, M.D.  “We are using many of the lessons that we learned from the Medicare RAC program in the development and implementation of the Medicaid RACs, including a far-reaching education effort for health care providers and State managers.”

Under the Affordable Care Act, States must establish Medicaid RAC programs by submitting state plan amendments to CMS by December 31, 2010.  The law allows CMS to provide extensions or exceptions to States, if necessary, and details regarding these processes are included in the proposed regulation.  In addition, the proposed regulation issued by CMS today outlines the requirements that states must meet and the Federal contribution CMS will provide to assist in funding the state RAC programs.

Medicaid RACs will be paid by the States on a contingency basis to review Medicaid provider claims, identify and recover overpayments made for services provided under Medicaid State plans and Medicaid waivers.  The proposed regulation allows States the discretion to determine whether to pay their Medicaid RACs on a contingency basis or under some other fee structure for identifying underpayments.     

CMS is encouraging interested parties to comment on the proposals included in the regulation.  These include the payment methodology for identifying overpayments and underpayments as well as the recovery of overpayments and correction of underpayments, and the requirement that RACs report fraud or criminal activity whenever they have reasonable grounds to believe such activity has occurred.

Under the regulation, as proposed, a State may use its current administrative appeals process or may modify its process for Medicaid RAC-related appeals.  All fees paid to the Medicaid RACs must come from amounts recovered after all available appeals have been exhausted.

Because CMS has proposed to require States to implement their programs in a timely manner, CMS is providing educational programs to help States understand both the Medicare and Medicaid RAC programs.    On October 1, 2010, CMS released a State Medicaid Director letter which provided initial guidance to the States regarding the RAC program.  CMS issued an educational DVD entitled “Medicaid RACs: Are You Ready?” targeted to State Medicaid and Program Integrity Directors and held a webinar for states offering RAC procurement tips.  Additionally, on November 4, 2010, CMS hosted an educational forum describing Lessons Learned from CMS’s experience with Medicare RACs.

A copy of the regulation may be viewed at the Federal Register’s website, http://www.ofr.gov/inspection.aspx.  For Additional information on the Affordable Care Act can be accessed at, http://www.healthcare.gov/.  

State Medicaid Director Letter Recovery Audit Contractors (RACs) for Medicaid

Final Rule
New Medicaid Regulations, October 2010

This is why nothing gets done with Medicaid fraud in child welfare

Sure, you can contact your elected officials.  After one of the staffers for constituency services sends you a totally irrelevant letter of referral to the same people you reported to about Medicaid fraud, the rest of your letters go unanswered.  This process of constituency services even works on a Congressional level.


You call the U.S. Department of Health and Human Services Regional Office to report waste, abuse and fraud and you get a really nasty upper echelon diva telling you to put it in writing, to which you never, ever get a response.


Or, you could simply keep sending stuff to your State Medicaid Fraud Control Unit in the Attorney General Office where the Attorney General has Assistances who can fashion up a really snazzy letter of dismissal.


Perhaps, you push the correct sequence of legalese and find yourself hauling boxes of actual documents to show the Inspector General and U.S. Attorney General only to be later told that you cannot do it yourself.


All I can say is Carmel Wilson should be honored for who she truly is, and that is a whistleblower.

Carmel Wilson

Sharp Hinchey aide foils Medicare scam

Carmel Wilson, who works as an aide to Rep. Maurice Hinchey in his Middletwon office, was one of the first people to notice the proliferation of Medicare recipients complaining of procedures they said they never received, in places they had never been.

MIDDLETOWN — Right made might in the three-year hunt to get to the bottom of who was responsible for absurdly suspicious Medicare charges that began to appear on medical statements of people in the Hudson Valley in 2007.
A modest public servant and Orange County mother of two played a huge role in bringing down what the FBI says is an international crime organization that bilked Medicare out of millions with bogus claims.

Carmel Wilson, a longtime aide to Rep. Maurice Hinchey who works in his Middletwon office, was one of the first people to notice the proliferation of Medicare recipients coming into her office with charges for procedures they said they never received in places they had never been – like California or Arizona.

118 sham clinics

On Wednesday, the U.S. Attorney General unsealed two indictments, charging 44 alleged members and associates of an Armenian-American crime organization with Medicare fraud.

Wilson provided information used against 40 of the defendants, according to officials in Hinchey's office. The mobsters worked out of New York City and Los Angeles, but many of the identities used for the claims likely were obtained from a 2005 data breach at Orange Regional Medical Center, authorities said. Hospital spokesman Rob Lee said the hospital has reached out to law enforcement officials to help them determine if the breach occurred within the hospital or at another site.

The FBI said Armenian mobsters billed more than $163 million in false claims to Medicare, making this the largest, single Medicare fraud case in history. Medicare paid out over $35 million in U.S. taxpayer money to at least 118 sham clinics in 25 states, according to the indictment.

Wilson is a shy, sweet woman with short red hair who roots for the Mets. She says she loves her job as a liaison between ordinary folks and the federal government because she can help so many people. Before working for Hinchey she worked for former Rep. Ben Gilman.

She's an unlikely candidate for striking a blow against what the FBI says is a Mafia-like organization complete with a Tony Soprano-like boss, called a vor, which is roughly the equivalent of a Mafia godfather, who once threatened to “disembowel” a man who owed him money and to kill an associate who failed to show him proper respect.

Wilson goes to FBI

Wilson, nevertheless, relentlessly documented each suspicious billing incident. Then she would send out letters with the support of her boss to both the Medicaid fraud division and the Medicare billing contractor.

Since states usually contract their Medicare billing out to other states — New York's billing is done in Minnesota, for instance — there was a fair amount of red tape involved.

When Wilson didn't see enough movement to resolve the issue, she contacted the FBI.

Warren Smith of Middletown says he estimates about $50,000 was billed under his name in fraudulent claims. At first, he tried to report the fraud to Medicare himself. “Have you ever called Medicare?” Smith asked. “You wait forever.”

Medicare asked Smith to contact the provider to see if it was a clerical error. It was pretty hard to contact nonexistent clinics, he said.

Frustrated he turned to Wilson. Subsequently, he was involved in the FBI investigation. “I was glad to learn about the indictments,” Smith, 76, said. “(Wilson) is awesome.”